Provider Demographics
NPI:1750431524
Name:MASANGYA, MARITESSA INOVIO (DDS)
Entity type:Individual
Prefix:
First Name:MARITESSA
Middle Name:INOVIO
Last Name:MASANGYA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 SANTA OLIVIA RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2807
Mailing Address - Country:US
Mailing Address - Phone:619-482-2550
Mailing Address - Fax:
Practice Address - Street 1:2207 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-6905
Practice Address - Country:US
Practice Address - Phone:619-292-2996
Practice Address - Fax:619-292-2571
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47946122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist